Treatment patterns and long-term outcomes in anti-VEGF-treated macular oedema secondary to retinal vein occlusion: a retrospective observational study

Abstract

Background/objectives: This study reported real-world visual acuity (VA), treatment patterns, and ocular safety outcomes from patients with macular oedema secondary to branch, central, or hemi-retinal vein occlusion (BRVO, CRVO, HRVO) treated with anti-vascular endothelial growth factor (VEGF). Methods: Data were collected from Medisoft electronic medical records across 16 NHS ophthalmology sites in England over 60 months. Results: 3511/3465 eyes/patients with BRVO and 3568/3514 eyes/patients with CRVO or HRVO were included; <2% of patients had bilateral RVO and had both eyes included. VA change from index anti-VEGF treatment was lower with longer follow-up. In BRVO eyes, mean (95% CI) change in VA from index was +11.2 (10.6, 11.7) approximate Early Treatment Diabetic Retinopathy Study (ETDRS) letters at Month (M)6 and +8.3 (6.7, 10.0) at M60. Mean (95% CI) change in VA for CRVO/HRVO eyes was +11.5 (10.7, 12.3) approximate ETDRS letters at M6 and +7.0 (4.8, 9.2) at M60. Eyes receiving more injections displayed greater average VA gains. Median (Q1–Q3) annual number of anti-VEGF injections was lower in BRVO and CRVO/HRVO eyes with longer follow-up: M12, 7.0 (5.0–8.0) and 6.0 (4.0–8.0); M60, 2.0 (0.0–5.0) and 1.0 (0.0–5.0). Ocular safety outcome incidence through 60 months was low (endophthalmitis, retinal tears, and retinal detachment <1%). Conclusions: VA improvements were observed soon after anti-VEGF treatment, but were lower with longer follow-up through 60 months, alongside lower annual injection numbers, suggesting that current single-target intravitreal anti-VEGFs may not be sufficiently durable for long-term RVO management in routine practice.